


Nightingale

by Boton



Category: Upstairs Downstairs, Upstairs Downstairs (1971)
Genre: Episode S04Ep11 Missing Believed Killed, Gen, Hurt/Comfort, Major Character Injury, Missing Scene, World War I
Language: English
Status: Completed
Published: 2017-04-03
Updated: 2017-04-03
Packaged: 2018-10-14 13:17:34
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 2,939
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/10537278
Author URL: https://archiveofourown.org/users/Boton/pseuds/Boton
Summary: As her step-cousin, James, remains missing at the front, Georgina tends to her nursing duties at a casualty clearing station. But when James is brought to her hospital, can her loving care bring him back from the brink of death without sending them both into the beginnings of an unwise romance?





	

**Author's Note:**

> This story takes place in the lacunae of the fourth season episode, “Missing, Believed Killed.”
> 
> Rated T for descriptions of war wounds and surgical care.
> 
> Upstairs, Downstairs was produced by London Weekend Television and was distributed by several companies, including ITV and Acorn Media Group. Some dialog has been taken from the episode. This work is for my pleasure and that of my readers; I am not profiting from the intellectual property of any of the show’s creators.

“Georgina! Georgina!”

When Georgina heard her name called across the field hospital, she initially thought of quickening her steps and continuing on out into the rainy night without turning back. The day had been exhausting – soul-crushing, really. The rain meant an influx of patients who were chilled to the bone and crusted with mud, having made the journey from the front with no opportunity for anything but the most cursory of care. New patients had flooded the hospital and spilled out into every hallway and corner, until some poor souls still waited outside, lying on the ground on their stretchers huddled under tarps. Georgina had spent the day prepping countless patients for surgery, changing piles of bloody dressings, bringing cups and cups of weak but hot tea and cocoa, and holding hands while two favorite patients slipped away. Now, all she wanted was to take off her shoes and her apron and crawl into bed.

She quickly came awake, however, when she heard her colleague whisper two words: James Bellamy. The name on the dog tags of the soldier who had just been brought inside. Georgina ran to the bedside of the soldier, holding her breath.

At first, he looked like any other soldier. Woolen uniform soiled and sodden, a bloody bandage sliding down over his left eye obscuring his face, and a visibly-rapid respiration rate. She quickly made her way to the bed and sat down on the edge. 

“Jumbo!” she exclaimed, falling back on the family nickname. But James was far away, staring at a point only he could see in what the experienced nurses called a “thousand yard stare.” Georgina turned to her colleague and quickly dismissed her. “I’ll take care of him,” she whispered frantically.

Just then, Sister Menzies bustled over, her ever-present frustration with the strains of the work showing. “Nurses, what are you doing? It doesn’t take two of you to care for this man. Worsley, why are you here; I dismissed you. You need to get your rest before you come back on shift.”

“Oh, please, Sister,” Georgina said. “This is my cousin, James. We thought he was killed; he’s been missing for over a week, and my family has been worried sick. I’ll stay and take care of him; I don’t need the rest, truly.”

Sister merely nodded, then turned to Georgina’s compatriot and said, “Very well. Nurse, to your duties, immediately.” And with that, Georgina was left alone with James.

Normally, Georgina could work without thinking too much about who her patient was or where he had been; that kind of personal level of care would wait until he had made it through surgery or treatment, and she could sit by a bedside to help with a cup of tea, a cigarette, or a conversation about home. But as she worked, she couldn’t help but glancing back to James’s face, watching him grip the bed frame above his head every time his body shifted, his breath coming faster with the pain.

She started with his trousers. Using the big shears, she cut them away from his legs and his body, stopping only at the wound on his right knee. There, she took trembling hands and gently peeled the wool away from the wound, noting the way the fabric had been pushed inside by the impact of the shell fragment that was surely also still inside. James gasped as she worked, making pained noises that were half word, half cry, until Georgina had removed as much of the fabric and mud from the wound as she could.

Next, she turned her attention to his pants, making quick work of the thin fabric, and rapidly covering James with a sheet to preserve both warmth and dignity. It was funny, she thought. Not too long ago, as a debutante, she wasn’t allowed to be in the same room with a man unless she had a chaperone. Now, she routinely touched the most private parts of a man’s body with a clinical detachment that surprised her when she took the time to think about it. The soldiers who were awake and alert for this part of the process were often much more embarrassed than she could possibly be after this many months of nursing; thank heavens James was beyond caring.

Finally, she took up the shears a last time and began cutting away his uniform coat and the shirts he wore underneath. All were stained with sweat, filth, and blood that could not possibly have come from the wounds on either James’s head or knee. When she reached James’s right arm, she paused and put her hand on his, still gripping the bed frame.

“Jumbo? You need to let go, just for a minute. I need to get your jacket off so I can make you warmer and more comfortable.”

James grabbed the frame tighter, looking at Georgina for the first time with wild, frightened eyes.

“Georgina?” he muttered, confused. “Tell them,” he began, trailing off, as Georgina finally succeeded in freeing his right arm and cutting off the coat sleeve.

“I’ll tell them,” she prompted. “What do you want me to say?”

“I won’t be down for breakfast today,” he muttered, his head falling to the left and his eyes drifting closed.

Georgina stroked his face. He was burning up; no doubt he was febrile from both infection in his wound and the shock he was still in. “Of course,” she said softly. “Breakfast will be there when you’re ready to get up. Mrs. Bridges will put something back for you.”

James muttered again softly, once again near catatonic. Pulling up the sheet to James’s shoulders, Georgina went to the pantry to get a basin of warm water and a cloth.

Returning to James, she began to bathe him and to unwrap his bandages so the surgeon could survey him. His head wound looked bad at first glance, but, once she had washed his face and soaked the dried blood from it, she saw that it was merely a deep cut, not the penetrating head wound she had first feared.

Moving down his body, she worked section by section, carefully washing him clean a bit at a time while keeping the rest of him covered. When she reached his right knee, she stopped. 

While she had some idea of the severity of the injury from her initial exploration, her ablutions made it clear that the wound was getting worse. Dirt, dried blood, and fragments of cloth clung to the wound and well inside it, while the edges were taking on an angry, red, puffy look. Georgina closed her own eyes for a minute; this was the way gangrene started, a sure path to an amputation. Thinking of James losing his limb above the knee was almost more than she could bear.

At that moment, Surgeon Major Rice arrived, looking more like a butcher than a physician with his apron stained in blood. He was conducting his usual survey of the new wounded, deciding who would go to surgery first, who could wait, and who could only be kept comfortable.

Rice stopped, reached down, and probed the wound with his fingers, making James gasp and cry out, even from his stupor.

“This one goes first,” Rice said. “The more serious cases are beyond help, and some of the others need longer procedures. With this one,” he said, flipping the sheet back over James’s knee, “we may be able to save the limb if we debride quickly enough.”

“Oh, yes, please, Major!” Georgina exclaimed. “He’s ready now; you can take him any time you like.”

Rice grunted. “Has he had his tetanus, Nurse?” he asked.

Georgina indicated the syringe in the kidney basin. “Just going to, Surgeon Major.”

“Very well. See that he gets it, then send him in with the orderlies. I have just enough time for a cup of tea with that ghastly condensed milk.”

***

When James returned from surgery, he was pale and looked, if possible, worse than he had when he arrived. Clad only in a hospital gown and with a fresh bandage around his head, he was muttering incoherently and tossing his head from side to side. Georgina tucked him into bed with a fresh sheet and blanket, then propped his injured leg on a pillow, looking at the dressing to be sure it was still clean. 

Underneath, she knew, was a horror that was excusable only because it may save James’s limb. Major Rice had removed the shell fragment and debrided the wound, cutting away skin and the muscle beneath until a crater remained in the flesh, left open to prevent the growth of the anaerobic bacteria that caused gas gangrene. The wound was dressed with an initial bandage soaked in antiseptic, then wrapped well to hold it together and allow the healing to start. The pain from such a wound would be tremendous, and James must be kept perfectly still to allow the tissues to knit together; until they did, he would be dependent on morphine to keep the pain at bay.

As Georgina pondered this, James’s eyes seemed to clear a bit, and he muttered, “where?” before his skin took on a greenish cast. Georgina had seen the after effects of ether many times, and she gently turned him to the side so he could vomit into the basin she held. With nothing to bring up, James gagged, heaved, and every spasm jarred his knee and his head until he began to sob. Georgina held him as best she could, bracing him over the basin as she had so many soldiers before, and muttering endearments until he had passed through the worst of it and she could administer the morphine that would bring him relief and sleep.

***

_James alive. Seriously ill but in good hands. Hopeful. Love, Georgina._

Georgina sent the telegram the next day, as soon as she’d handed James’s care off to the next shift and fallen into bed herself. As soon as she returned to the hospital for her next shift, however, she regretted sending it at all. 

Walking into the surgical wing to begin her shift, Georgina was struck by James’s condition. His face was shiny with perspiration, and his mussy hair was soaked with it. He was alternately tossing his head side to side and crying out from the pain, and his hands clenched the sweaty sheets, rolling them in his palms and periodically clutching them to his chest.

“He’s been like this all night,” said the nurse handing off to Georgina. “Fever keeps climbing higher and higher, and he’s been out of his head the entire time.”

“How’s his leg?” Georgina asked.

“About the same. No new signs of infection, but he will hardly let us touch it, even to change the dressing, poor thing.”

Georgina nodded, then went for a basin of tepid water and a cloth. Returning to James’s bed, she began to gently wash him, spending extra time sponging his head, neck, and hands in an effort to make him feel cooler.

“Mother?” James mumbled, eyes opening but clearly not seeing.

“No, not Aunt Marjorie. It’s Georgina, Jumbo,” Georgina said softly.

“Mother, it hurts,” he mumbled again.

“Of course it does, darling,” Georgina crooned. “We’re going to fix that right now.”

Checking the chart, Georgina was relieved to see that James was due another dose of morphine, which she quickly drew up and administered. James soon quieted and passed quickly into sleep, leaving Georgina quite alone with her thoughts.

***

Over the next week, Georgina pulled double shifts as much as Sister would allow, dividing her time between James and the rest of her patients. For James, she changed sweaty sheets several times a day; checked under his dressing obsessively, looking and smelling to detect the first signs of the dreaded gangrene; and, when he was more alert, coaxed him to take sips of sugary tea, hoping that the warm beverage would sooth him into consuming some nutrition, even if it did nothing to bring down his fever.

“Worsley,” Sister Menzies began one day when Georgina was disinfecting basins in preparation for blanket baths for her patients. “Even though he doesn’t have the most serious wound, you must remember what your cousin went through before we got him. Even with the best of care, sometimes they are beyond our help.”

Georgina’s head jerked up. “I know, sister. That is, I know it happens, but it won’t to James. I won’t allow it. He’s mine to care for, and I won’t permit even the thought.”

Sister shook her head minutely, then said, “I think you would also do well to remember that he is your cousin, nurse.” And with that comment, she left the room.

Georgina shook her head. Sister was being uncharacteristically oblique with her comments, but Georgina knew that she was being warned against developing too much of an affection for James. It was silly, really.

Georgina knew that many men fell in love with their nurses while in hospital; how could they not? A young man, delivered directly from the horrors of the trenches, cared for by a young, pretty nurse who reminded him of home and who could deliver the pain relief and euphoria of morphine? It was nearly impossible for them not to mistake this for love; Georgina and all of the nurses had dozens of marriage proposals every time they loaded their patients into ambulances to make their way back to a base hospital for the next stage of recovery.

Nurses, however, were expected to maintain a professional distance; it was the only way they could function, seeing the men they cared for suffer and perhaps die under their care. Nurses could not afford the luxury of emotional involvement, or it would tear them apart.

But this was different, Georgina thought. James was her cousin – her step-cousin, really. Why, the King of England himself was more closely related to the Kaiser and the Tsar who he was fighting than Georgina was to James!  


And no one, ever, would be able to understand what they had shared over here, during the war. This experience was theirs, and theirs alone, all the horror and pain and hopefully James’s eventual recovery belonged to just them. No one at home could ever share this, not Uncle Richard, and certainly not Hazel, whose experience of war was limited to working her canteen hours far removed from the front. Hazel could never understand this, Georgina thought.

Georgina roused from her thoughts as James suddenly jerked forward, sicking up the tea she had just gotten him to consume and moaning again through the pain the motion caused. With a sigh, Georgina settled him back, then began the process of changing gown and linens and washing him clean.

**

By the seventh day after his surgery, Georgina had nearly given up hope that he would ever be fully lucid again. However, when she arrived for her shift that day, Sister quietly told her, “his fever broke in the night.” Georgina rushed to James’s bed to check for herself, Sister following behind.

For the first time, James looked up at her with something resembling a purpose in his gaze. Geogina moved to place her hand on his cheek, feeling the normal temperature there and looking back at Sister with a smile.

“He’s still quite disoriented, but we may be out of the woods,” Sister said. “Now, see to it you remember you have more than one patient.”

Geogina nodded, helped James with a drink of water which he took wordlessly, then went about her duties. Every time she passed James’s bed, she looked over, watching him pass in and out of sleep. He could only stay awake for a very few minutes, but, for the first time, he was not continually moaning in pain.

At the end of her shift, once every bed had been changed, every bed pan emptied and washed, every basin sterilized, and every dose of medication given, Georgina went to sit by James’s bed. She held his hands while he slept and gazed at him, taking in the strong jaw and soft lips as well as the terrible gash on his forehead and the eyes reddened from exposure to the gas. As she did so, James woke and recognized her.

“How long have I been here?” he asked.

“A week,” she said simply.

“What are you doing?” he asked, his brow furrowing slightly.

“I’m looking after you; you’re in my hospital.”

With that, he grimaced. “My leg…”

“You were wounded just above your right knee. They removed a piece of shell from it. The pain will ease,” she said, holding his hands more tightly.

James drifted off to sleep, but he startled when Georgina tried to extract her hands.

“I’ll be back in the morning,” she said softly, freeing her hands to stroke him softly on the cheek. “Try and get some sleep.”

James fell asleep once again, and Georgina marveled at just how weak he was. To bring him back to his former strength would take weeks of care, but that was care she was happy to provide. She had a smile on her face as she returned to her quarters, to find a telegram from home waiting on her bunk.

_Arriving end of week for James. Anxious to see you. Love, Uncle Richard and Hazel_

Georgina carefully put the telegram in drawer and began to remove her soiled apron and shoes. It would be so nice to see her family again; they would be sure to feel better after a visit and after seeing James in her care.

**Author's Note:**

> I chose the title “Nightingale” after the idea of “Nightingale syndrome,” in which a wounded patient falls in love temporarily with his nurse. Interestingly, Google Ngrams shows that the phrase was not widely in use (if at all) until the late 1950s.
> 
> **
> 
> Gas gangrene was a serious problem during WWI because of the terrible conditions in the trenches and the tendency for the wounds to be penetrating ones, driving soil-bourne anaerobic bacteria deep into the injury. Closing the wound, then, would create exactly the oxygen-free environment needed for the bacteria to flourish, creating a gangrenous condition. Early in the war, almost the only treatment for wounds that might become gangrenous was amputation, although some wounds could be debrided, as mentioned in the story. The important factor was that the wound remain open and exposed to oxygen to keep any remaining bacteria from growing. 
> 
> Late in the war, a new treatment, called the Carrel-Dakin method, gave some options for treating these wounds. Looking somewhat like a drip hose for gardening, the apparatus involved delivered a slow infusion of an antiseptic solution to the wound, continually fighting the bacteria. Because we don’t see such an apparatus being used on James in the episode, I have taken the artistic liberty of assuming that the staff at Georgina’s hospital know of the theory and might have dressed his wound with antiseptic-soaked bandages, at least right after surgery.


End file.
